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General NPI Number Information
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NPI Number | 1972547719
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Entity Type | Organization
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Legal Business Name | OCTAGON PHARMACEUTICAL INC
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 1809 VERDUGO BLVD STE 110
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City | GLENDALE
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State | CA
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Zip | 91208-1402
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Country | US
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Telephone | 818-952-2108
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Fax | 818-952-2149
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Provider Business Mailing Address
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Address Line | 1809 VERDUGO BLVD STE 110
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City | GLENDALE
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State | CA
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Zip | 91208-1402
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Country | US
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Telephone | 818-952-2108
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Fax | 818-952-2149
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Authorized Official
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Title or Position | PRESIDENT/PIC
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Name | ELLIE YAZDI
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Credential |
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Telephone | 818-952-2108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 51780
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License Number State | CA
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